Table 1.
Observational studies analyzing risk factors for poor outcome among patients with carbapenem-resistant Enterobacteriaceae infection
| References | Number of patients and type of infection | Microbiological characteristics | Definition of outcome and observed rates | Unmodifiable conditions associated with outcome | Treatment factors associated with outcome |
|---|---|---|---|---|---|
| Nguyen et al. [96] | 48 (all BSI) | CR-KP |
30-day mortality 42% |
Persistent bacteremia at day 7 | Source control (protective factor) |
| Neuner et al. [97] | 60 (all BSI) | KPC |
14-day mortality 42% |
High Pitt score | No relationship was found between therapy and outcome |
| Zarkotou et al. [98] | 53 (all BSI) | KPC |
Infection mortality 34% |
Age APACHE II score at infection onset |
Appropriate antimicrobial treatment (protective factor) |
| Qureshi et al. [33] | 41 (all BSI) |
21 KPC-1 20 KPC-3 |
28-day mortality 39% |
Pulmonary source Cardiovascular disease Chronic liver disease |
Combination therapy (protective factor) |
| Tumbarello et al. [37] | 125 (all BSI) |
98 KPC-3 27 KPC-2 |
30-day mortality 41.6% |
Septic shock High APACHE III |
Inadequate initial antibiotic therapy Combination therapy with tigecycline, colistin and meropenem |
| Capone et al. [42] | 97 (34 BSI) |
89 KPC-3 5 CTX-M-15 3 VIM-1 |
In-hospital mortality 26% for all the infections 47% for BSI |
Charlson index ICU stay at infection onset BSI Colistin resistant strain |
No relationship was found between therapy and outcome |
| Daikos et al. [29] | 205 (all BSI) |
163 KPC (36 plus VIM) 42 VIM |
28-day mortality 40% |
Severity of underlying disease Septic shock Monotherapy |
Combination therapy (combination including carbapenem was associated with better outcome, mainly if carbapenem MIC was ≤8 mg/l) |
| Gonzalez-Padilla et al. [41] | 50 (24 pneumonia, 18 BSI) | Outbreak of highly resistant KPC clone. All isolates were resistant to colistin and had meropenem MIC >32 mg/l |
30-day mortality 38% |
Age Severe sepsis/septic shock Neoplasia |
Optimal targeted treatment with gentamicin |
| Tumbarello et al. [36] | 661 (447 BSI) |
497 KPC-3 164 KPC-2 |
14-day mortality 34% |
BSI Septic shock APACHE III score Chronic renal failure Colistin-resistant isolate Inadequate empirical treatment |
Combination therapy (combination including carbapenem was associated with better outcome at univariate analysis, mainly if meropenem MIC was ≤8 mg/l) |
BSI bloodstream infection, CR-KP Carbapenem-resistant Klebsiella pneumoniae, ICU intensive care unit, MIC minimum inhibitory concentration, KPC K. pneumoniae carbapenemase, VIM Verona integron-encoded metallo-β-lactamase